From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires

Abstract

Abortion stigma is experienced not only by women but also by providers and health professionals in a wide range of legal contexts. This paper analyses interviews with providers who work in the public health system in the Metropolitan Area of Buenos Aires, Argentina. A court ruling in 2012, FAL/12, changed the interpretation of abortion's legal status, clarifying the decriminalisation of abortion in cases of rape, and also requiring public policies and procedures to speed up access to legal abortion. Between 2014 and 2017, we conducted 27 in-depth, semi-structured interviews with abortion providers in public facilities across healthcare services in the Metropolitan Area of Buenos Aires. We found the way that health providers dealt with abortion stigma evolved over the course of time, as the abortion debate moved from the margins to the heart of political debate and public policies in Argentina between 2007 and 2017. Providers' experiences changed as the social and legal context changed. FAL/12as a clear, legal rulingwas a landmark and turning point in the way health professionals in public health facilities conduct their activities, making it possible for them to move from providing silent and hidden abortion care, to acknowledging it with pride.

Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care

“…The failure to acknowledge existing abortion services, as well as the tactics used to do so were discussed in 22 studies ( Aniteye and Mayhew, 2013 ; Cárdenas et al, 2018 ; Dahlback et al, 2007 ; Deb et al, 2020 ; de Vries et al, 2020 ; Esia-Donkoh et al, 2015 ; Fernández Vázquez and Brown, 2019 ; Freedman et al, 2010 ; Homaifar et al, 2017 ; Ireland et al, 2020 ; 20, Margo et al, 2016 ; Påfs et al, 2020 ; Payne et al, 2013 ; Pheterson and Azize, 2008 ; Puri et al, 2012 ; Raifman et al, 2018 ; Sri and Ravindran, 2012 ; Suh, 2018 ; Ushie et al, 2019 ; Weitz and Cockrill, 2010 ; Yegon et al, 2016 ). Providers did not advertise their services due to stigma and fear of legal repercussions ( Aniteye and Mayhew, 2013 ; Deb et al, 2020 ; de Vries et al, 2020 ; Seewald et al, 2019 ) (also see manifestation 6, Punishment and threats).…”

“…Other examples of misclassification of diagnosis included “diagnostic D&C” or “preeclampsia” ( de Vries et al, 2020 ). Some providers described the use of “medical records that were not official” or the use of aliases on prescriptions to ensure secrecy ( Fernández Vázquez and Brown, 2019 ).…”

The role of healthcare providers in expanding legal abortion: Qualitative insights from Argentina, Ireland, and South Korea

“…At the same time, it is known that the political and social contention around abortion can hinder the engagement of healthcare providers and organizations in political and law-making processes. 14,23,29,[31][32][33] Hostility against frontline health workers and advocates, particularly those working for sexual and reproductive health and rights such as safe abortion, is a reality. 34 Hence, healthcare providers can fear negative reactions, personal attacks, and stigmatization as a consequence of their engagement.…”

“…14,17 In Argentina, Ghana, and Ethiopia, healthcare providers were involved in developing policies and guidelines for abortion provision. 14,20,31 Lastly, WHO's definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" has been cited by healthcare providers in Argentina, Ghana, and Chile as a ground for broad interpretation of health and subsequent wider provision of legal abortion services. 18,20,29 The recognition of the diversity of potential roles of healthcare providers is key to ensure and extend their engagement in law and policy-making processes, which is of clear importance to effectively expand regulatory frameworks on abortion.…”

Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review

“…Health services need to enact structural and policy reform to create safe, inclusive, and respectful environments for people both providing and accessing SRH services. In some instances, stigma and discrimination can affect both the healthcare users and providers of sexual and reproductive health care, as can occur with abortion care [79]. As such, it is likely that effective interventions will be complex, operating across multiple levels to maximize the likelihood for change.…”